title: Femoral neck shortening after internal fixation of a femoral neck fracture.
abstract: This study assesses femoral neck shortening and its effect on gait pattern and muscle strength in patients with femoral neck fractures treated with internal fixation. Seventy-six patients from a multicenter randomized controlled trial participated. Patient characteristics and Short Form 12 and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were collected. Femoral neck shortening, gait parameters, and maximum isometric forces of the hip muscles were measured and differences between the fractured and contralateral leg were calculated. Variables of patients with little or no shortening, moderate shortening, and severe shortening were compared using univariate and multivariate analyses. Median femoral neck shortening was 1.1 cm. Subtle changes in gait pattern, reduced gait velocity, and reduced abductor muscle strength were observed. Age, weight, and Pauwels classification were risk factors for femoral neck shortening. Femoral neck shortening decreased gait velocity and seemed to impair gait symmetry and physical functioning. In conclusion, internal fixation of femoral neck fractures results in permanent physical limitations. The relatively young and healthy patients in our study seem capable of compensating. Attention should be paid to femoral neck shortening and proper correction with a heel lift, as inadequate correction may cause physical complaints and influence outcome.
authors.affiliation: Departments of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Zielinski
authors.forename: Noël L
authors.initials: NL
authors.lastname: Keijsers
authors.forename: Stephan F E
authors.initials: SF
authors.lastname: Praet
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Heetveld
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Wilssens
authors.forename: Peter
authors.initials: P
authors.lastname: Patka
authors.forename: Esther M M
authors.initials: EM
authors.lastname: Van Lieshout
mesh_terms: D000368:Aged; D005260:Female; D005265:Femoral Neck Fractures / Q000453:epidemiology* / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data*; D017102:Fracture Healing; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D007870:Leg Length Inequality / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D020127:Recovery of Function; D012307:Risk Factors; D016896:Treatment Outcome